(Circulation. 1995;91:1706-1713.)
© 1995 American Heart Association, Inc.
Articles |
Occult and Frequent Transmission of Atherosclerotic Coronary Disease With Cardiac Transplantation
Insights From Intravascular Ultrasound
From the Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to E. Murat Tuzcu, MD, Department of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F-25, Cleveland, OH 44195-5066.
Background Transplant coronary artery disease is a major cause of morbidity and mortality after cardiac transplantation. However, limited data exist regarding the potential contribution of coronary atherosclerosis in the donor heart to cardiac-allograft vasculopathy.
Methods and Results We performed quantitative coronary
angiography and intravascular ultrasound imaging in 50 of 62
consecutive heart-transplant recipients (40 men, 10 women, mean age,
53±9 years) 4.6±2.6 weeks after transplantation. The donor
population
consisted of 30 men and 20 women (mean age, 32±12 years). Ultrasound
imaging visualized all three coronary arteries in 22 patients, two
coronary arteries in 23, and one coronary artery in 5. Ultrasound
imaging detected coronary atherosclerosis (intimal thickness 
0.5 mm)
in 28 patients (56%). However, the angiography was abnormal in only 13
patients (26%). The sensitivity and specificity of coronary
angiography were 43% and 95%, respectively. With ultrasound, the
average atherosclerotic plaque thickness was 1.3±0.6 mm and the
cross-sectional area narrowing was 34±16%. Atherosclerotic
involvement frequently was focal (85%), eccentric (mean eccentricity
index, 87±8), and near arterial bifurcations. Donors of the transplant
recipients with coronary atherosclerosis were older than those without
atherosclerosis (37±12 versus 25±10 years, P=.001).
Maximal intimal
thickness correlated with donor age (r=.54,
P=.0001). Multivariate analysis demonstrated that donor
age (P=.0001), male sex of donor (P=.0006),
and
recipient age (P=.03) were independent predictors of
atherosclerosis.
Conclusions Coronary atherosclerosis is frequently but inadvertently transmitted by means of cardiac transplantation from the donor to the recipient. Long-term outcomes of donor-transmitted coronary artery disease will require further evaluation.
Key Words: transplantation • coronary disease • ultrasonics
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